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New Study: St. John’s Wort as effective as Prozac for Major depression with fewer side effects

By HBC Protocols October 08, 2008 0 comments

LONDON, (Reuters) – The herbal remedy St. John’s Wort effectively treats symptoms of major depression, an analysis of previous studies found on Wednesday. St. John’s Wort extracts tested in the different trials were better than placebos and as effective as standard antidepressants with fewer side effects, the researchers reported in the Cochrane review, a journal that analyses medical and scientific studies. “The studies came from a variety of countries, tested several different St. John’s Wort extracts, and mostly included patients suffering from mild to moderately severe symptoms,” Klaus Linde of the Centre for Complementary Medicine in Munich, Germany wrote. The herb works in a similar way to some prescription antidepressants by increasing the brain chemical serotonin, involved in controlling mood. The Cochrane review analysed 29 studies that together included 5,489 men and women with symptoms of major depression and compared the remedy’s effectiveness with placebos and standard treatments. The researchers found that St. John’s Wort extracts were not only effective but that fewer people taking them dropped out of the trials due to adverse side effects. They also noted that results were more favourable in German-speaking countries where doctors often prescribe the remedy and cautioned against using the remedy without medical advice because the extracts can affect other drugs’ work. In Germany such herbal treatments are also more controlled for content, unlike in many other markets where the quality and content of herbal products may vary considerably. “Using a St. John’s Wort extract might be justified, but products on the market vary considerably, so these results only apply to the preparations tested,” Linde said. Depression is a leading cause of suicide and affects about 121 million people worldwide, according to the World Health Organisation. Standard treatments include Prozac, which U.S. drugmaker Eli Lilly and Co (LLY.N: Quote, Profile, Research, Stock Buzz) introduced in 1987. The treatment, which belongs to a class of compounds called selective serotonin reuptake inhibitors (SSRIs), is now off patent and widely available generically as fluoxetine. (Reporting by Michael Kahn; Editing by Maggie Fox)

St John’s Wort for depression (Cochrane Review) abstract

Linde K, Mulrow CD, Berner M, Egger M

Summary – Available evidence suggests that several specific extracts of St. John’s wort may not be effective for treating mild to moderate depression.

 

Extracts of St. John’s wort (botanical name Hypericum perforatum L.) are prescribed widely for the treatment of depression. They seem more effective than placebo and similarly effective as standard antidepressants for treating mild to moderate depressive symptoms. Beneficial effects for treating major depression appear minimal. Side effects are usually minor and uncommon. However, as extracts of St. John’s wort can influence adverse effects of other drugs, patients should consult their physicians before using St. John’s wort. The results of this review apply only to the preparations tested in trials; the content of marketed preparations might vary considerably from those tested in trials.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Linde K, Mulrow CD, Berner M, Egger M. St John’s Wort for depression. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub2
This version first published online: October 26. 1998
Date of last substantive update: February 25. 2005

Abstract

Background

Extracts of the plant Hypericum perforatum L. (popularly called St. John’s wort) have been used in folk medicine for a long time for a range of indications including depressive disorders.

 

Objectives

To investigate whether extracts of hypericum are more effective than placebo and as effective as standard antidepressants in the treatment of depressive disorders in adults; and whether they have have less adverse effects than standard antidepressant drugs.

Search strategy

Trials were searched in computerized databases (Cochrane Collaboration Depression, Anxiety & Neurosis Group Clinical Trials Registers; PubMed); by checking bibliographies of pertinent articles; and by contacting manufacturers and researchers.

Selection criteria

Trials were included if they: (1) were randomized and double-blind; (2) included patients with depressive disorders; (3) compared extracts of St. John’s wort with placebo or standard antidepressants; and (4) included clinical outcomes such as scales assessing depressive symptoms.

Data collection and analysis

Information on patients, interventions, outcomes and results was extracted by at least two independent reviewers using a standard form. The main outcome measure for comparing the effectiveness of hypericum with placebo and standard antidepressants was the responder rate ratio (responder rate in treatment group/responder rate in control group). The main outcome measure for adverse effects was the number of patients dropping out for adverse effects.

Main results

A total of 37 trials, including 26 comparisons with placebo and 14 comparisons with synthetic standard antidepressants, met the inclusion criteria. Results of placebo-controlled trials showed marked heterogeneity. In trials restricted to patients with major depression, the combined response rate ratio (RR) for hypericum extracts compared with placebo from six larger trials was 1.15 (95% confidence interval (CI), 1.02-1.29) and from six smaller trials was 2.06 (95% CI, 1.65 to 2.59). In trials not restricted to patients with major depression, the RR from six larger trials was 1.71 (95% CI, 1.40-2.09) and from five smaller trials was 6.13 (95% CI, 3.63 to 10.38). Trials comparing hypericum extracts and standard antidepressants were statistically homogeneous. Compared with selective serotonin reuptake inhibitors (SSRIs) and tri- or tetracyclic antidepressants, respectively, RRs were 0.98 (95% CI, 0.85-1.12; six trials) and 1.03 (95% CI, 0.93-1.14; seven trials). Patients given hypericum extracts dropped out of trials due to adverse effects less frequently than those given older antidepressants (Odds ratio (OR) 0.25; 95% CI, 0.14-0.45); such comparisons were in the same direction, but not statistically significantly different, between hypericum extracts and SSRIs (OR 0.60, 95% CI, 0.31-1.15).

Authors’ conclusions

Current evidence regarding hypericum extracts is inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that the tested hypericum extracts have minimal beneficial effects while other trials suggest that hypericum and standard antidepressants have similar beneficial effects. As the preparations available on the market might vary considerably in their pharmaceutical quality, the results of this review apply only to the products tested in the included studies.

 

St. John’s wort relieves symptoms of major depression
Public release date: 8-Oct-2008 
New research provides support for the use of St. John’s wort extracts in treating major depression. A Cochrane Systematic Review backs up previous research that showed the plant extract is effective in treating mild to moderate depressive disorders.
“Overall, we found that the St. John’s wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects,” says lead researcher, Klaus Linde of the Centre for Complementary Medicine in Munich, Germany.
Extracts of the plant Hypericum perforatum, commonly known as St. John’s wort, have long been used in folk medicine to treat depression and sleep disorders. The plant produces a number of different substances that may have anti-depressive properties, but the whole extract is considered to be more effective.
Cochrane Researchers reviewed 29 trials which together included 5,489 patients with symptoms of major depression. All trials employed the commonly used Hamilton Rating Scale for Depression to assess the severity of depression. In trials comparing St. John’s wort to other remedies, not only were the plant extracts considered to be equally effective, but fewer patients dropped out of trials due to adverse effects. The overall picture is complicated, however, by the fact that the results were more favourable in trials conducted in German speaking countries, where St. John’s extracts have a long tradition and are often prescribed by doctors.
Despite the favourable findings for St. John’s wort, researchers are anxious not to make generalisations about the plant’s use as an anti-depressant and recommend consulting a doctor in the first instance, especially as the extracts can sometimes affect the actions of other beneficial drugs.
“Using a St. Johns wort extract might be justified, but products on the market vary considerably, so these results only apply to the preparations tested,” says Linde.

St John’s wort ‘eases depression’

St John’s wort does alleviate the symptoms of depression, experts have concluded.

By Kate Devlin, Medical Correspondent 
Last Updated: 12:36AM BST 08 Oct 2008
stjohnwort
Extracts of St John’s wort have been used for centuries to treat depression and sleep conditions Photo: PA 
The herbal medicine, taken by millions every year, can help sufferers with a severe form of the condition, scientists said. Previous reports have suggested that the remedy could be beneficial to people suffering from milder types of the disease. Extracts of St John’s wort have been used for centuries to treat depression and sleep conditions. 
Researchers from the Cochrane Library looked at 29 trials of 5,489 patients with symptoms of major depression. They found that the herb performed as well as even more traditional medication.  “Overall, we found that the St. John’s wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects,” says Klaus Linde, from the Centre for Complementary Medicine in Munich, Germany, who led the study. 
However, he warned that some of the studies looked at could contain unintentional biases, as the findings were more favourable in trials conducted in German-speaking countries, where the herbal extract is in common use and is often prescribed by doctors. Those worried that they have depression should also consult a doctor, he added. “Using a St John’s wort extract might be justified, but products on the market vary considerably, so these results only apply to the preparations tested,” he said. The herbal remedy has been investigated in the past for possible dangerous reactions with prescription drugs.

Release Date:October 7, 2008, 7:01 PM US Eastern time 
St. John’s Wort Helps Some Patients With Major Depression 
By Glenda Fauntleroy, Contributing Writer 
Health Behavior News Service


The herbal medicine St. John’s wort appears to work just as well as some prescribed antidepressants for treating patients with major depression, a new review finds. However, patients in German-speaking countries might experience the best benefits.

While there is public interest in the United States about whether St. John’s wort adequately treats depression, in some countries, like Germany, doctors commonly prescribe it for mild symptoms. Authors of the review found that studies with German patients did, in fact, have the best results.

“The most striking finding from our review is that trials from German-speaking countries have clearly more positive effects, both compared to placebo and standard antidepressants, than trials from elsewhere,” said lead reviewer Klaus Linde of the Centre for Complementary Medicine Research at Technical University in Munich. “In principle, we can say that hypericum extracts work in German-speaking countries, but we are less certain for other countries.” 

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

A person could be experiencing major depression when depression symptoms interfere with his or her ability to work, sleep, eat and take pleasure in activities previously enjoyed. The symptoms usually last for at least two weeks, but can often last longer than several months. St. John’s wort (an extract of the plant Hypericum perforatum L.) is an herbal alternative for patients who do not want prescribed antidepressants.

Exactly how the herb works to treat depression is unclear, partly because the extracts can contain at least seven groups of components, according to the reviewers. There is also no regulation on what the extract must contain. 
“There is no patent protection on herbs; therefore, more or less anyone can market hypericum extracts,” Linde said. “The products on the market vary enormously in their quality and content in active ingredients.” 

Linde added that consumers should be aware that many St. John’s wort products on the market have very low concentrations (such as dosages of less than 300 milligrams per day), and therefore, probably act only by placebo effects.


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